RAND Study Examines Access to Dental Care in Pennsylvania

Although it is preventable, dental disease is perhaps the most prevalent chronic childhood illness in the United States. According to the Centers for Disease Control and Prevention, 20 percent of children 5 to 11 years old have one tooth with untreated decay, a situation that may lead to more severe health problems. Youth from lower-income families have a higher rate of untreated tooth decay than their peers.

As dental care has long been a component of public health policyRAND examined access to dental care across Pennsylvania using a series of indicators to determine the distribution and available of dentists and dental hygienists. Two counties (Potter and Juniata) did not meet the guideline of full-time dentist per number of residents. Other counties varied greatly across study indicators. A sample of findings:

  • Two counties do not have dentists that accept Medicaid.
  • 58 percent of counties in Pennsylvania do not have pediatric dental specialists.
  • High unemployment rates were associated with fewer providers of dental care.
  • The Head Start program appears to be a successful method in getting dental care to children who might not otherwise have access to it.

The full report, including a discussion of associations of the study’s access-to-care indicators to each other, as well as to county demographics, is available for download on the RAND website.



Citation:  Baird, Matthew D., Michelle K. Baird and Joseph V. Vesely. Access to Dental Providers in Pennsylvania: Exploration of the County-Level Distribution of Dental Providers and Populations in 2013. Santa Monica, CA: RAND Corporation, 2016. http://www.rand.org/pubs/research_reports/RR1351.html.


New Data: Prevalence of Mental Health Diagnoses, Prescriptions Among Foster Care Youth

The 2013 report Diagnosis and Health Care Utilization of Children who are in Foster Care and Covered by Medicaid, from the Substance Abuse and Mental Health Administration (SAMHSA) is loaded with useful data, including those showing a stark contrast in the prevalence of mental health diagnoses between Medicaid-covered youth in foster care and their peers outside the child welfare system.  While recent research indicates that the increase in psychiatric diagnoses and office visit rates for U.S. youth outpace those of adults (based on comparison of data from the latter half of the 1990s and 2007-2010),  mental illness and psychiatric disabilities appear to be more prevalent among children in foster care than in the general population (a trend also found in countries outside of the United States).

The SAMHSA report divides findings into age groups (and is available at their website in PDF form), but some of the overall trends include:

  • Mental health diagnoses (49 percent) rates among foster care youth covered by Medicaid was higher in 2010 than their counterparts not in foster care (11 percent)
  • Children in foster care had more outpatient visits and longer lengths of an average inpatient stay than those not in foster care

Among adolescents (ages 12-17):

  • Attention-deficient, conduct and disruptive disorder were the most common diagnoses in 2010, occurring in 38 percent of foster care youth compared to 11 percent of their peers outside of foster care
  • 40 percent of 12-17 years olds in foster care used prescription medication related to a mental health diagnosis

In light of these trends, it might be worth noting that a December 2012 report from the Government Accountability Office raised concerns to the Department of Health and Human Services’ over appropriate treatment of mental illness and use of prescribed psychiatric medication for children in Medicaid or in the foster care system (the majority also covered by Medicaid). Their report found that youth covered by Medicaid were twice as likely to take anti-psychotic medications than privately insured youth, but may not have received counseling or additional mental health treatment other than the medication.



Report Citation: Center for Mental Health Services and Center for Substance Abuse Treatment. Diagnoses and Health Care Utilization of Children Who Are in Foster Care and Covered by Medicaid. HHS Publication No. (SMA) 13-4804. Rockville, MD: Center for Mental Health Services and Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2013.


Number of Insured Adults Increases

The steady increase of uninsured persons in the United States changed direction in 2011, with an overall decline in the number of uninsured persons age 64 and under (categorized as non-elderly by the Census) according to the Kaiser Commission on Medicaid and the Uninsured.  This trend reversal seems to be linked to coverage changes in Medicaid and the Children’s Health Insurance Program (CHIP).  While coverage for children remained stable between 2010 and 2011, it increased among non-elderly adults. Although the proportion of low-income adults increased in 2011, so did the number of insured adults.

This decline and the coverage and population factors that may have influenced it are discussed in the brief Reversing the Trend? Understanding the Recent Increase in Health Insurance Coverage among the Nonelderly Population  by John Holahan and Megan McGrath of The Urban Institute.  The complete paper is available at the Henry J. Kaiser Family Foundation website.

Kaiser Reports on Trends in Medicaid Eligibility and Enrollment

A report released earlier this year from the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families details the state of Medicaid eligibility and enrollment in the country, as well as what may need to occur to put Medicaid-related provisions in place as required by the Affordable Care Act (ACA).

Some highlights from the report:

  • 37 states now have an online application for Medicaid or CHIP – an increase of 12 percent since January 2012, while 36 states currently provide online accounts.  More than half  (28) of the states in the nation have made it possible for families to renew their coverage online, an increase of 40 percent since last year’s report.
  • Overall,  families were not burdened with extra cost requirements via the states in the past year.   Premium adjustments were few, with 9 states increasing the copay requirement.

The report Getting into Gear for 2014:  Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2012–2013, and a webcast from the January 2013 briefing are available at the Kaiser Family Foundation website.